Happy New Year,
We are acutely aware of how busy life is for everyone which is why we decided to produce a succinct review of the previous month's simulations. We have incorporated our top 3 takeaways from last months' observations, adding some aviation examples and content that we hope you will find interesting.
3. Working Environment
Use of Physical copies of Checklists/Algorithms/Protocols - Similarly to aviation, the medical environment is susceptible to change when it comes to procedures and protocols. The demands on clinicians to be mentally up to date and correctly recall all of these changes is a huge ask when fatigued or under stress. In aviation, finding the relevant information from a handbook or on the iPad is not a sign of weakness, in fact quite the opposite - it shows an awareness of wanting to get things right the first time and saving capacity for more critical tasks such as key decision-making or coordinating the team. Mentor Pilot gives an excellent demonstration on how to follow a checklist using the 'challenge and response' technique.
Use of 'read-back' for critical tasks and drug dosage requests - This is a bit of a WingFactor favourite! With the changes to the working environment (PPE, closed doorways, use of walkie-talkies) what better way to ensure accuracy of information transfer - both to the receiver and also from the sender, than to immediately confirm the instruction. In aviation, we are taught this principle from day one as it is a vital safety layer in our primary form of communication. Here is an aviation example where ATC (Air Traffic Control) made a rare mistake - immediately picked up by the pilots on approach.
Our working environment - The end of December saw one of our most ambitious sims yet, with a Covid -19 VF arrest scenario in the back of an ambulance. One of the key takeaways focused on how the cramped conditions within the ambulance greatly impacted communication. We have also seen similar challenges in the ED side rooms. Add variables such as redeployed staff and Covid-19 protocols (PPE), it can be a hugely challenging set of circumstances. How do we manage this? In aviation, we draw on threat error management - we brief methods to Avoid, Trap and Mitigate the threats associated with our dynamic operating envelope (E.g. Weather, terrain, visibility). If you find yourself in an unusual environment at the hospital it may be worth considering "what has changed, how will this affect the safety of our operation, and what can we do as a team to mitigate the associated threats?".
The Boeing 737 max is due to restart commercial ops in Europe by late January 2021, having already restarted in the US and Brazil. This comes amid a US senate report criticising the handling of the crisis by both Boeing and the FAA (Federal Aviation Authority) at an organisational level.The first accident occurred in October 2018 when a Lion Air 737 Max came down in the sea off Indonesia. An Ethiopian Airlines version then crashed shortly after take-off from Addis Ababa, just four months later. Both have been attributed to flawed flight control software, which became active at the wrong time and prompted the aircraft to go into a catastrophic dive. With such a well documented and checkered past in the public domain, it will be interesting to see how European airlines plan to market the restart of 737 Max operations with confidence in the product still at an all-time low.
EASA (European Aviation Safety Association) have published proposed conditions for return to service, which includes a focus on pilot training and updates to operational manuals. It seems that EASA have addressed every layer of the James Reason Human Factors ‘Swiss Cheese’ model prior to re-certification. Time will tell.
Thanks to a recommendation from Whittington's very own Doctor Robbie Lloyd aka Pondermed, I managed to pick up a copy of 'Peak' over the festive period. From what I've read so far, Anders Ericsson's research into the 10,000 hour rule teaches us that true genius isn't an innate talent. Years of deliberate practice may well be putting an end to the talent vs skill debate. Great news for our iterative sim project over the coming year!
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